Early alcohol experiences and adolescent mental health: A population-based study in Taiwan

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Abstract

In this study, we examine whether adolescent emotional and behavior problems vary by history of early alcohol experiences. A national sample of 6974 alcohol-naïve and 4337 alcohol-experienced youths aged 15–18 years were identified within the 2004 National Survey of Illegal Drug Use among Adolescents in Taiwan. Four alcohol experience groups were created based on recency and frequency of alcohol use: (1) naïve; never drank alcohol, (2) trial use; first and only consumption of alcohol occurred more than 6 months preceding the assessment, (3) past use; alcohol used on more than one occasion but had not had a drink in the 6 months prior to the assessment, and (4) current use; consumed alcohol more than once and drank within the 6 months preceding the interview. A Chinese adaptation of the Youth Self-Report (YSR) assessed eight behavior syndromes: withdrawn, anxious/depressed, somatic complaints, social problems, thought problems, attention problems, rule-breaking behavior, and aggressive behavior. Multivariate response models (GLM/GEE) were used to examine the relationship of alcohol experiences with emotional and behavior problems. Alcohol-using youth were more likely to experience several specific emotional or behavioral syndromes than their alcohol-naïve counterparts. For example, youth with a history of alcohol use had an estimated 30–60% increase in the odds of experiencing items within the aggressive behavior syndrome as compared with alcohol-naïve youth. The type of early alcohol involvement in adolescence may exert differential effects on emotions and behaviors expressed across and within syndromes; these may warrant distinctions in informing etiological research and preventive efforts.

Introduction

Most individuals with alcohol problems initiate drinking during adolescence, a period when not only the body is changing dramatically, but behavioral, cognitive, emotional, and attitudinal changes also take place (Dawson, 2000, Grant et al., 2006, Maggs and Schulenberg, 2005, Semlitz and Gold, 1986). Repeatedly using alcohol (frequency or quantity) at such a critical stage in life may result in detrimental effects on brain development. For example, alcohol exposure in adolescence has been associated with a greater risk of disrupted hippocampus functions, including memory, in animal models (e.g., Spear, 2002, Spear and Varlinskaya, 2005, White and Swartzwelder, 2005). These alcohol-related cognitive, emotional, and behavioral impairments may then furthermore exert a cascading effect on subsequent health and adjustment (National Research Council, 2004).

Psychiatric problems are apparent among youth with alcohol disorders and episodic heavy drinking patterns (Kumpulainen, 2000, Tapert et al., 2002, Townshend and Duka, 2005). A prospective follow-up of a community sample of 2500 adolescents found that social phobia and panic disorders were not only associated with persistent alcohol abuse/dependence but also predicted the onset of regular alcohol use, defined as having alcohol at least three times a week (Zimmermann et al., 2003). Several explanations have been suggested for the apparent excess of mental health problems among alcohol users. The “shared vulnerability model” posits that there are underlying genetic or other general susceptibility traits that contribute to both alcohol use and observed psychological or behavioral disturbances (Baigent, 2005). Other explanations either assume that some psychiatric disturbances might prompt alcohol taking (e.g., individuals with depressed moods might use alcoholic beverages to self-medicate) (Bolton et al., 2006, Crum et al., 2008, Kumpulainen, 2000) or that alcohol consumption gives rise to or exacerbates the emergence of psychiatric disturbances (Haynes et al., 2005). However, the observed co-occurrence may be a mix of two-directional processes. Although there is a growing body of evidence suggesting a link between alcohol abuse/dependence or heavy drinking with mental health problems, there are reasons to believe that the observed association may hold for those with less problematic alcohol involvement (e.g., experimenters or occasional users) (Poulin et al., 2005, Saluja et al., 2004). For instance, in a sample of adolescents aged 14–18 years recruited in western Oregon, the lifetime prevalence rate of depression was 17% among alcohol abstainers, whereas the corresponding estimates for experimental, social, and problem drinkers were 23%, 21%, and 39%, respectively (Rohde et al., 1996).

In order to assess a broad spectrum of maladaptive functioning and psychological problems in adolescents, Achenbach et al. (1991) have developed widely used instruments that at low cost obtain standardized data. One of the instruments is the Youth Self-Report (YSR), which seeks information from youth themselves and assesses eight emotional and behavioral syndromes (Achenbach, 1995). Until recently, many studies either have totaled YSR item scores to create scale scores that are then gauged by some cut-point criteria (e.g., T-scores or percentiles) or have compared mean scores within a particular syndrome for subgroups of individuals with different substance-using experiences (Rey et al., 2002, Ernst et al., 2006). One limitation of these scoring approaches is that they fail to take into account the interdependencies that exist within the patterns of an individual's response to the YSR items (e.g., individuals who report the experiences of “would rather be alone” may be more likely to report the presence of other items in the withdrawn syndrome). Another possible limitation is they do not capture the link between substance use and the individual YSR items within the syndromes. Thus, these types of analyses are unable to distinguish whether the observed substance use-associated elevated risk of mental health problems is a result of a few high-scored items, or due to a general increase in all of the items within a syndrome. Alternative statistical approaches that emphasis the contribution of specific items within a scale may be useful in identifying mental health disturbances among youth in early stages of alcohol involvement because these youth may not experience a syndrome-level effect of their alcohol use yet, but their alcohol use may trigger the onset of specific reactions at a subthreshold level. Such distinctions would be useful for identifying individuals at risk for alcohol-related cognitive, emotional, and behavioral impairments within a developmental framework.

To address the gap in literature on the link between early alcohol experiences and mental health disturbances, we turned to epidemiological survey data collected from a nationally representative sample of Taiwanese youth. With a primary focus on early alcohol use in a social context wherein alcohol initiation occurs mostly at family social events by late childhood or early adolescence (Chen et al., in press), the aim of this study was to examine the extent to which different types of early alcohol involvement were associated with emotional and behavioral indicators across and within syndromes. Considering that the association between alcohol use and mental health problems can be more complicated when multiple alcohol intake parameters are taken into account (e.g., drinking frequency and length of abstinence), the profile of mental health indicators were examined in relation to four subgroups of alcohol experiences: naïve, experimenters, past use only, and current use. Observed alcohol-related variation in the experience of mental health indicators between alcohol-naïve (never drank alcohol) and alcohol experienced youth may provide some etiological and preventive suggestions regarding alcohol initiation; whereas a comparison between alcohol experimenters with past- and current- alcohol users (used alcohol on more than one occasion but differ on the timing of the last drink relative to the date of assessment) may indicate possible changes and stability of mental health problems in relation to increase or discontinuity of alcoholic beverage consumption.

Section snippets

Sampling and data collection

The data for this study are drawn from the 2004 National Survey of Illegal Drug Use among Adolescents (NSIDA) a cross-sectional school survey of a nationally representative sample of youth between the ages of 12–18 years in Taiwan. From lists obtained from the Ministry of Education, 133 schools were randomly selected using multistage sampling procedures, with school type (i.e., middle school, senior high school, and vocational/technical high school) and region (defined by geographic

Results

A description of demographic characteristics and lifetime drug-related experiences is presented for each of the alcohol involvement subgroups in Table 1. In general, alcohol using adolescents were more likely to be male, to come from single-parent households, to have more allowance, to live separately from their family, and to use drugs, as compared with their alcohol-naïve counterparts. The proportion of youth initiating alcohol use before the age of 13 years did not vary across the three

Discussion

Our findings indicate that among a national sample of high school-attending youths in Taiwan, the youth who had the experience of drinking alcohol were more likely to experience several specific emotional or behavioral syndromes and items within those syndromes than their alcohol-naïve counterparts. For example, youth with a history of alcohol use had an estimated 30–60% increase in the odds of experiencing items within the aggressive behavior syndrome as compared with alcohol-naïve youth. In

Conflict of interest

All other authors declare that they have no conflicts of interest.

Acknowledgements

Special thanks will be given to Dr. Chih-Yin Lew-Ting, Dr. Ching-Mei Lee, Dr. Cheng-Fang Yen, Dr. Duan-Rung Chen, Dr. Chaucer C.H. Lin, Dr. Ming-Jen Yang, and Dr. Te-Jen Lai for their help in the deign and conduction of the National Survey of Illegal Drug Use among Adolescents.

This work was supported by DOH93-NNB-1012 (WJC), DOH94-NNB-1014 (WJC), DOH95-NNB-1012 (WJC), NHRIMDPP04-014 (CYC), and NIDA DA016323 (CLS).

Contributors: C.-Y. Chen was responsible for data analyses and led the writing of

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